Kolek Martin, Brat Radim
Department of Cardiac Surgery, University Hospital Ostrava, Ostrava, Czech Republic -
Department of Cardiac Surgery, University Hospital Ostrava, Ostrava, Czech Republic.
Minerva Cardioangiol. 2017 Aug;65(4):336-347. doi: 10.23736/S0026-4725.17.04331-6. Epub 2017 Mar 1.
There are limited contemporary data on the safety and efficacy of echo-guided pericardiocentesis following cardiac surgery in Europe. The aim of the study was to review tertiary cardiac surgery center experience with postoperative pericardial effusion (PE) diagnosis and treatment.
A total of 6830 patients underwent open-heart surgery at our center between December 2004 and November 2016. Of these patients, 208 (3%) required pericardiocentesis for significant PE.
There was a significant reduction of the incidence of substantial PE requiring pericardiocentesis by use of alternative surgical pericardial cavity drainage system (the accessory Redon drain positioned along the diaphragmatic surface of the heart) compared to conventional retrosternal chest tube drainage (3.3% vs. 2.1%). The rate/relative risk of pericardiocentesis was significantly higher after valve surgery, aortic root and ascending aorta surgery, and surgical ablation of atrial fibrillation-i.e. among patients who had received postoperative anticoagulation therapy. Clinical manifestations of cardiac tamponade were observed in 36% of patients, while progressive large PE without tamponade was evacuated in 41% of patients. Initial echo-guided pericardiocentesis was therapeutically effective in 98.6% of cases, and the rate of major complications was 1%. There was no mortality related to pericardiocentesis. Eighteen patients (8.7%) required repeated pericardiocenteses due to recurrent effusion. Fifteen patients (7.2%) in the pericardiocentesis group required surgery due to recurrent effusion, persistent bleeding, or clotted hemopericardium.
Echo-guided pericardiocentesis was very effective and safe method for primary treatment of postoperative PE. Most patients did not require further intervention after this treatment.
在欧洲，关于心脏手术后超声引导下心包穿刺术的安全性和有效性的当代数据有限。本研究的目的是回顾三级心脏外科中心对术后心包积液（PE）的诊断和治疗经验。
2004年12月至2016年11月期间，共有6830例患者在我们中心接受了心脏直视手术。其中，208例（3%）因大量心包积液需要进行心包穿刺术。
与传统的胸骨后胸管引流相比，使用替代性手术心包腔引流系统（沿心脏膈面放置的副雷顿引流管）可显著降低需要心包穿刺术的大量心包积液的发生率（3.3%对2.1%）。在瓣膜手术、主动脉根部和升主动脉手术以及房颤手术消融后，即接受术后抗凝治疗的患者中，心包穿刺术的发生率/相对风险显著更高。36%的患者出现了心脏压塞的临床表现，而41%的患者排出了无压塞的进行性大量心包积液。初次超声引导下心包穿刺术在98.6%的病例中治疗有效，主要并发症发生率为1%。没有与心包穿刺术相关的死亡病例。18例（8.7%）患者因复发性积液需要重复进行心包穿刺术。心包穿刺术组中有15例（7.2%）患者因复发性积液、持续出血或心包积血凝块而需要手术。
超声引导下心包穿刺术是术后心包积液初步治疗的非常有效且安全的方法。大多数患者在接受这种治疗后不需要进一步干预。
